Filariasis is a common healthcare problem in Tropical countries caused by nematodes of the order Filariidae. Typical clinical manifestations include a subclinical syndrome, Acute adenolymphangitis (ADL), Filarial fever (characterized by fever without associated adenitis) and Tropical pulmonary eosinophilia (TPE). Unusual manifestations include a subcutaneous nodule, filariasis of breast, lymphadenovarix in the axilla and others. Massive hemorrhagic pericardial effusion due to Filariasis is rare. Diethylcarbamazine is the treatment of choice.

1. International Journal of Healthcare and
Medical Sciences
ISSN: 2414-2999
Vol. 2, No. 1, pp: 1-4, 2016
URL: http://arpgweb.com/?ic=journal&journal=13&info=aims
*Corresponding Author
1
Academic Research Publishing Group
An Uncommon Presentation of Filariasis
Waseem Raja Dar*
MD MACP MCCP, Department of Internal Medicine Sanjeev Bansal Cygnus Hospital
Najeebullah Sofi MBBS MD, Department of Internal Medicine Rockland Hospitals
Imtiyaz Ahmad Dar MBBS MD, Department of Internal Medicine Advanta Hospital
Pervez Sofi Department of Critical Care Medicine Sanjeev Bansal Cygnus Hospital
Farhat Abbas Department of Pathology SKIMS
1. Introduction
Filariasis is a disease group affecting humans and animals, caused by filariae; i.e., nematode parasites of the
order Filariidae. Of the hundreds of described filarial parasites, only 8 species cause natural infections in humans.
These include Wuchereria bancrofti, Brugia malayi, and Brugia timori, Loa loa, Onchocerca
volvulus, and Mansonella streptocerca, Mansonella perstans and Mansonella ozzardi. Based on the predominant
organ involvement these are classified into three groups: cutaneous group, lymphatic group and body-cavity group.
The parasites of the cutaneous and lymphatic groups are the most clinically significant. Typical clinical
manifestations include a subclinical syndrome, Acute adenolymphangitis (ADL), Filarial fever and
Tropical pulmonary eosinophilia (TPE) [1-3] Unusual manifestations include a subcutaneous nodule, Filariasis of
breast, lymphadenovarix in the axilla and others. Onchocerciasis is characterized by hanging groins, leopard skin and
river blindness whereas Loiasis presents as subcutaneous swellings on the extremities, localized pain, pruritus and
urticaria. Massive pericardial effusion due to Filariasis is rare. We here present a patient who presented to us with
symptomatic hemorrhagic pericardial effusion that was proved to be caused by Filariasis.
2. Case Report
A 26 year old male, resident of West Bengal, presented to the Emergency Department of our hospital with
complaints of fever and progressive breathlessness of one month duration with recent worsening. Patient did not give
any history of cough, sputum production, chest pain, loose motions or dysuria. However there was recent history of
travel to his native place. On general physical examination, patient had tachypnea, tachycardia and fever (1010
F).
His cardiovascular examination revealed muffled heart sounds whereas abdominal examination revealed moderate
hepatomegaly. His respiratory and neurological examinations were normal. Patient was admitted and put on broad
spectrum antibiotics and other supportive treatment. Blood investigations were normal (Table 1). X ray chest
revealed an enlarged cardiac silhouette (Fig 1). Electrocardiogram revealed low voltage complexes.
Echocardiogram revealed massive pericardial effusion with evidence of impending cardiac tamponade (Fig 2).
Therapeutic and diagnostic pericardiocentesis was done. Pericardial fluid showed lymphocytic pleocytosis with
numerous microfilaria (Fig 3). Gram stain or AFB stain didn’t reveal any microorganisms. Peripheral blood was
negative for microfilariae. Patient was put on Diethylcarbamazine (100 mg tid for 21 days). Patient improved
significantly and his fever and breathlessness resolved. Patient is presently on our follow up and is doing fine.
Abstract: Filariasis is a common healthcare problem in Tropical countries caused by nematodes of the order
Filariidae. Typical clinical manifestations include a subclinical syndrome, Acute adenolymphangitis (ADL),
Filarial fever (characterized by fever without associated adenitis) and Tropical pulmonary eosinophilia (TPE).
Unusual manifestations include a subcutaneous nodule, filariasis of breast, lymphadenovarix in the axilla and
others. Massive hemorrhagic pericardial effusion due to Filariasis is rare. Diethylcarbamazine is the treatment of
choice.
Keywords: Filariasis; Pericardial effusion; Diethylcabamazine.

2. International Journal of Healthcare and Medical Sciences, 2016, 2(1): 1-4
2
3. Discussion
Lymphatic Filariasis is a common public health problem of tropical and subtropical countries. Chowdhary, et al.
[4] It is transmitted by the Culex mosquito and is caused by two closely related nematodes, W. bancrofti and Brugia
malayi, which are responsible for 90% and 10% of the cases, respectively. The adult worm resides in lymphatic
vessels, while the larval forms, microfilariae, circulate in the peripheral blood. Pericardial effusion is an uncommon
manifestation of Filariasis. Chylous serous effusions may occur in Filariasis. However, hemorrhagic effusions are
very rare in Filariasis and are usually suggestive of malignancy. The portal of entry of microfilariae to the pericardial
space is still not known. Microfilariae probably appear in tissue fluids due to lymphatic or vascular obstruction by
scars or tumours, extravasation or damage to vessel walls by inflammation, trauma or stasis. Munish, et al. [5]
reported a case of Filarial Pericardial Effusion causing cardiac tamponade which subsequently resolved with
treatment with pericardiocentesis and Diethylcarbamazine (DEC). Prasanthi, et al. [6] reported a case of unresolving
pericarditis that was found to be due to microfilariasis and that resolved with antihelminthic drugs. Paul [7]
Peripheral blood smears may be negative for Mf in cases of secondary manifestations of Filariasis. Our patient also
presented with massive pericardial effusion with impending tamponade secondary to Filariasis that resolved with
Diethylcarbamazine and pericardiocentesis.
4. Conclusion
In conclusion, microfilariasis should be considered as a cause of pericardial effusion in persons residing in
endemic areas, in migrants from areas endemic for Filariasis and in visitors to endemic areas. Treatment is
Diethylcarbamazine.
References
[1] Arvindbhai, G., Bhanumati, S., Yoganand, V., and Lalita, G., 2007. "Subcutaneous filariasis: An unusual
case report." Indian Journal of Dermatology, vol. 52, pp. 48-49.
[2] Bhattacharjee, K., Ray, P., and Halder, S., 2012. "Filariasis of breast: An unusual presentation." Ann Trop
Med Public Health, vol. 5, pp. 376-378.
[3] Adhish, B., Sarath, C., Surendra, K., and Jagdish, S., 2006. "Lymphadenovarix in the axilla – an unusual
presentation of Filariasis." Filaria Journal, vol. 5, p. 9.
[4] Chowdhary, M., Langer, S., Aggarwal, M., and Agarwal, C., 2008. "Microfilaria in thyroid gland nodule."
Indian J Pathol Microbiol, vol. 51, pp. 94-96.
[5] Munish, S., Dinesh, G., and Sujata, J., 2014. "Case of filarial pericardial effusion (pe) presented as cardiac
temponade which subsequently resolved with treatment with pericardiocentesis and diethylcarbamazine."
Journal of Indian College of Cardiology, vol. 4, pp. 233-235.
[6] Prasanthi, K., Nagamani, K., and Saxena, K., 2010. "Unresolving pericarditis: Suspect filariasis in the
tropics." Indian J. Med. Microbiol, vol. 28, pp. 73-75.
[7] Paul, C., 1969. "Filariasis without Microfilaremia. Presidential Address." The American Society of Tropical
Medicine and Hygiene, Washington, D.C., pp. 181-189.

3. International Journal of Healthcare and Medical Sciences, 2016, 2(1): 1-4
3
Figure-1. Xray Chest showing enlarged cardiac sillhouete suggestive of pericardial effusion.
Figure-2. Echocardiogram of the patient showing massive pericardial effusion (arrow)

4. International Journal of Healthcare and Medical Sciences, 2016, 2(1): 1-4
4
Figure-3. High Power microscopy demonstrating microfilariae
Table-1. Investigations
Parameter Result Parameter Result Pericardial Fluid Analysis
Parameter Result
Hb 11 g% Urea 28 mg/dl TLC 8000 cells/mm3
TLC 8200/mm3
Creatinine 1.3 mg/dl Cell Type Lymphos=70%
Neutros= 10%
DLC Neutros=70%
Lymphos=21%
Eosinophils=5%
Bilirubin 1.45 mg/dl Glucose 63 mg/dl
PLT 3 lacs/mm3
ALT 54 U/L Protein 6.52 g/dl
MCV 79fL AST 56 U/L AFB Not Found
MCH 25.9 ALP 128 U/L ADA 143 U/L
ESR 42 mm/Ist hour Total Protein 6.76 g/dl
Albumin 3.8 g/dl